SleepDent

Actually, I was simply talking about UARS and not the poster's condition. I really should have addressed her question, but did not. You are correct, most insurances in the USA will pay for CPAP with an AHI greater than or equal to 5, and the AHI of 7 qualifies. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. UARS is a legitimate condition that can have many adverse medical consequences. On the scale of severity doctors consider the continuum to be(from low to high): snoring-UARS-mild OSA-moderate OSA-severe OSA. Certainly CPAP would be a possible treatment, but at this low end of severity an oral sleep apnea appliance would probably be a more rational choice for most people. CPAP is kind of an overkill in this instance and medical insurance will seldom(or, maybe, never) pay for CPAP to treat UARS. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

Most oral appliances work by protruding the mandible to open the airway. The OTC anti-snoring appliances have a lesser level of protrusion because they are dealing only with snoring and must appeal to a diverse audience of patients. Typically, you must obtain a much greater level of mandibular protrusion to treat moderate to severe sleep apnea. This is why you need a quality custom appliance carefully adjusted by a professional sleep dentist to exactly the right level of protrusion for each patient. American Academy of Sleep Medicine recommends oral appliances for both mild and moderate OSA and a high quality appliance works pretty reliably for both levels. For severe OSA, an appliance will give full resolution about 30% of the time and, in other cases, partial resolution, which may or may not be of practical use to the patient. Patients must understand. however, that there will be a significant number of clinical failures at any level, so success is not a certainty, any more than it is for CPAP. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. The snorex mouthguard is intended for snoring only and is not intended to treat obstructive sleep apnea. If you tried a high quality sleep apnea appliance, like the DreamTap, custom made by an experienced sleep dentist, chances are that the results would be sufficient. Of course, you are paying a lot more money, but, in this case, you get what you pay for and the sinus issues go away. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Basically, Sierra is right. The speed with which a patient gets symptomatic relief after treatment is initiated is highly variable. It is, sort of, on a statistical bell curve type of thing. Remember, untreated OSA has done a certain amount of damage to your body. First your body repairs the damage and THEN you start to feel better. Some people feel slightly better in a few days, some in a few weeks, or a month, or two months, or three months, or four, etc.. I would say that it would be highly unusual not to get some positive feed-back after six months, but, theoretically, it could take longer than that. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

Well, you actually get into some philosophical and judgement issues when treating severe OSA with oral appliances. In my own practice, I have had some stunning successes with oral appliances when treating severe sleep apnea. On the other hand, I have also had some absolute failures. By absolute failures, I mean that the baseline AHI was, say 50 and the oral appliance reduced it to 49. You never know. There is less data on treating severe OSA with oral appliances than mild to moderate. Historically, the TAP appliances have been as good as any for treating severe OSA. They will get the AHI down below 5 about 30% of the time. They will get the AHI down below 10 with total abolition of symptoms about 50% of the time. And they will reduce the AHI at least 50% to less than 20 about 69% of the time. This is in the hands of a very skilled sleep dentist with excellent technique. These figures would not be replicated by Mr. Average Dentist using the TAP. And these figures are certainly not a joke. They really don't escalate any risks except for the patient to be overly complacent about his situation. Clearly, you would like the treatment to be good enough so that the patient is not in clear and present danger of getting a heart attack or a stroke. There is no total consensus on how low the AHI has to get to take heart attack and stroke off the table. I best guess is that a fair number of practitioners would say that below 20 could be that point. So, I would say that, if a severe OSA patient uses an OA gets that gets him down to an AHI of, say, 19, vs. a baseline of 58 and he is less symptomatic and in less danger of getting a stroke or heart attack, you have done him some good. Actually, I have seen some data for the O2Oasys appliance with special tongue buttons and a nasal dilator that suggest that it may do far better against severe OSA than any previous appliances, but the data is too preliminary to be sure. Arthur B. Luisi, Jr.D.M.D.

Well, The American Association of Sleep Medicine recommends oral appliances as a valid alternative to CPAP for mild to moderate cases. That would put the diagnosed AHI at a maximum of 30. Oral appliances are less effective for severe sleep apnea, but not necessarily hopeless. My sense of it is that you would get a good result(treatment AHI less than 5) in about 30% of the severe cases. Typically, sleep doctors will try oral appliances for severe patients, who are CPAP intolerant, because they may get a somewhat decent result and some treatment is often better than none. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. Well, I guess that your story shows the inadvertent danger of getting into medical testing and then getting caught up in the licensure system with no easy way out. Maybe, rather than fighting the system, the easiest way out might to get an oral sleep apnea appliance. It is much more comfortable for most people that CPAP and should handle what minimal sleep apnea you have quite easily. The appliances are compact and very portable. Arthur B. Luisi, Jr., D.M.D.

I am a dentist working in dental sleep medicine. First, I would tell you not to try to use the appliance again until you seek professional help. A dentist who is well-version in the evaluation of TMJ problems needs to check you out and tell you your present status. The dentist who delivered the appliance should, theoretically, be able to do it, so, that would be a logical place to start. If he can't, look for someone better trained in TMJ. There is no way that I can help- you long distance, except for one thing. If you have the kind of oral appliance where the level of mandibular protrusion is adjusted on both the left and the right sides, it is possible that it got out of adjustment in such a way that one side is now protruded more than the other. If that happened, it would typically cause TMJ pain on one side. Again, don't attempt to fiddle with it yourself. Seek professional help. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.

I am a dentist working in dental sleep medicine. Unfortunately, there are a few people capable of exerting tremendous clenching and grinding forces with their teeth. I have one patient in my practice like that who has, so far, been able to destroy every device that I have placed in her mouth in short order. However, there may be some hope for you. The Dynaflex is one of a group of dorsal fin design OSA appliances. When you say that you have repeatedly broken off the fins, this indicates to me that you may be a severe lateral or side to side grinder. Dorsal fin appliances can only allow a very limited degree of lateral movement and may not accommodate your habit. Two appliances that can accommodate side to side grinding are the DreamTap and the EMA appliance with the flexible white straps. There is one other appliance, the Luco Hybrid, that is very stoutly made and specifically designed to hold up to severe bruxing. It was originated in Canada and is in limited distribution in the USA. This would probably be your best bet if you could find a dentist who is actually aware of it. You may also need to reduce your overall clenching habit by wearing a daytime clenching suppression appliance like the N.T.I. and getting physical or massage therapy to reduce the level of tension in your head and neck muscles. Since I have not examined you, consider these suggestions as possible topics for discussion between you and you health care providers and not as unsolicited medical advice. Arthur B. Luisi, Jr., D.M.D., The Naples Center For Dental Sleep Medicine.